1881015741 NPI number — BILTMORE EAR NOSE AND THROAT, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881015741 NPI number — BILTMORE EAR NOSE AND THROAT, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BILTMORE EAR NOSE AND THROAT, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881015741
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4400 N 32ND ST
Provider Second Line Business Mailing Address:
STE. 220
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85018-3953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-956-1250
Provider Business Mailing Address Fax Number:
602-956-7466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 N 32ND ST
Provider Second Line Business Practice Location Address:
STE. 220
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85018-3953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-956-1250
Provider Business Practice Location Address Fax Number:
602-956-7466
Provider Enumeration Date:
12/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TAFFET
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
602-956-1250

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  DA4099 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 849455 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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